Nurses in the hospice services

Hospice nurses are required to assist patients towards the end of their lives. Yet, numerous aspects of palliative care, such as end-of-life problems, psychosocial care, symptoms, and pain control, must be handled ethically. When interacting with patients at this level, nurses' professional positions require them to adhere to high levels of ethics, care standards, and values. Most importantly, they must ensure that the patient's needs are met at the end of life. Similarly, they should deliver patient-centered care while adhering to their professional principles and roles. The paper will analyse the case study in nursing involving Mr Newcomb who is in his final stages of life and the kind of care he needs. It will also explore principles of ethics, which are important in this scenario and strategies of self-care.

How to respond to Mr Newcomb Request

In this scenario, the nurse should make decision based on clinical standards and ethical principles (Izumi, Nagae, Sakurai, & Imamura, 2012). One of the most important cares that the nurse should start in this scenario is to begin communication by talking with Mr Newcomb who is dying. In most case, it is difficult and normally challenging to deal with the situation. Research has indicated that communication is vital feature of nursing in the care of terminally ill patients. In this case, the nurse should open up conversation with the patient (Butts & Rich, 2012). Appropriate communication facilitates the nurse to develop the wishes and priorities of the patient, helping him to make sound decisions. Through clear communication between the nurse and Mr Newcomb, it would offer a chance to examine any gaps and anxieties in understanding of the scenario (Grace, 2017). It could also reassure the patient, which plays a major role in reducing or alleviating distress and anxiety.

Furthermore, the nurse dealing with this case should also record the wishes of Mr Newcomb concerning the kind of demands with his family members. Continuing communication with him in a dignified and respectful way must continue even when he is unconscious because his sense of hearing can be sustained until demise (Izumi, Nagae, Sakurai, & Imamura, 2012). The nurse should also initiate sensitive communication between the patient and his close family i.e. his wife. It is vital to start, enable and respond to the patient’s wishes at this sensitive scenario. Moreover, the nurse should review the needs of the patients regularly because this stage of life is characterized by the ever-changing demands and landscape. Furthermore, the nurse should have constant communication with Mr Newcomb in order for every person to know what is taking place and why certain decisions have been taken (Butts & Rich, 2012). Finally, the nurse must ensure that the close family members and loved ones participate in maintaining close communication with the patients in order to encourage of his comfort (Grace, 2017).

Ethical principles in Oncology care

In the palliative care, nurses have a special responsibility of making ethical decisions when dealing with families and patients at their final stages of their life. In this regard, the nurse should be guided by ethical principles of Autonomy, Beneficence, Non-maleficence, Justice and Dignity. First, the principle of autonomy highlights the right of the patient to select or refuse their treatment (Grace, 2017). In this regard, it considered as the main element to ethical making of clinical decision. More importantly, this value highlights the need for the patient to make his decision that possesses the power to self-determination (Butts & Rich, 2012). The principle encourages the nurse to maintain the right of the patient to self-determination at all times regardless of whether he/she has lost the capability to make decisions.

In the case of Mr Newcomb, the nurse can accomplish this preservation via the suitable application of advance directives. If the patient is unable to make decision regarding his own health, his wife is responsible of decision making in lieu of him. However, the nurse should ensure that the principle of autonomy is not violated in case Mr Newcomb has the capacity to make decision or he has not designated a person to make decision on his behalf (Walker & Breitsameter, 2015). Moreover, the close relative tasked with the role of making decision should also understand the wishes of the patient hence the nurse should not accept actions that are contrary to the patient’s demands (Ranse, Yates & Coyer, 2012).

Secondly, the principle of beneficence demands that the nurse should work on the best interests of Mr Newcomb. Therefore, the nurse should always promote only what is beneficial or good for Mr Newcomb. Additionally, the choices and wishes of the patients should be advanced through proper caregiving and care planning (Butts & Rich, 2012). Similarly, the nurse’s obligation for Mr Newcomb should always be to advocate or strategies that enhance patient’s proper care at the end of life. Furthermore, the nurse must also ensure that his autonomy is not violated in an effort to do what the nurse considers is his best interest. The desire of the dying patient to select an alternative must be valued even if the nurse believes the alternative as not in the best interest of the patient (Izumi, Nagae, Sakurai, & Imamura, 2012). Therefore, the Mr Newcomb’s autonomy must carry the day over protectiveness.

The nonmaleficence principle calls for the nurse to avoid inflict intentional harm to the patient. The principle is based on the maxim of “Above all, do no harm”. Therefore, the nurse is encouraged to weigh the risk of initiating a particular treatment to the patient. On the other hand, the nurse should avoid granting the patient drugs that can cause harm or death even if he has asked for them (Grace, 2017). Furthermore, the justice principle calls for fairness in the health care delivery. In this case, the nurse should ensure that Mr Newcomb receives fair treatment at the end of his life. Precisely, nurses working in hospice services have an ethical responsibility of promoting appropriate and fair treatment of terminally ill patients at this point of their life (Walker & Breitsameter, 2015).

Personal beliefs and values

Various personal beliefs and values influenced the decision to care for the patient because values and ethics are closely linked which determine the actions of the nurse. More specifically, values affect the development of attitudes and beliefs rather than the nurse’s behaviour. People of diverse culture have different personal beliefs and values (Izumi, Nagae, Sakurai, & Imamura, 2012). Over the past few decades, the world has witnessed an increasing interest in the use of spiritual belief aiming to deal with stressful working environment among hospice services nurses (Ranse, Yates & Coyer, 2012).

Research indicated that personal beliefs are their individual convictions, beliefs and values that nurses possess concerning death and life. These practitioners utilize their personal beliefs to collaborate and assist families and patients in end-of-life care (Butts & Rich, 2012). More importantly, the personal beliefs of nurses have significant influence on the values ascribed to their work when dealing with terminally ill patients.

Specifically, in the above scenario, the nurse utilized the personal values of spirituality and religiosity. These values assisted the nurse to handle the situation of terminally ill patient. Moreover, the personal values and beliefs helped to boost ad sustain the confidence of the nurse in dealing with the process of caring Mr Newcomb and his family (Grace, 2017). For instance, the faith and personal experience in caring this kind of patient was instrumental to provide patient’s comfort and reduce his physical and psychosocial suffering. Similarly, knowledge, values and opinions assist to foster a good relationship between the nurse and the patient for better health outcome in the dying process (Walker & Breitsameter, 2015).

Humanization practices were also utilized to help Mr Newcomb and his family. These practices are patient-centred approaches used when the nurse is handling a terminally ill patient. Therefore, the nurse applied the moral responsibilities to ensure that Mr Newcomb had peach of mind in the process of dying. The comfort of the members of his family was also provided (Grace, 2017). To accomplish these objectives the nurse permitted visitation plans for religious people and family members, sustaining pain relief and careful hygiene. Such circumstances places the nurse before the suffering of the family members, which enable them to accept the family-centred care (Ranse, Yates & Coyer, 2012). Consequently, the nurse worked with the family members in order to understand the wishes of the terminally ill patient.

Strategies to promote Self-care

The Palliative and Oncology care is one of the most challenging and stressful working environment in hospital settings among nurses. The emotive environment of dealing with families and patients at the end of their lives is more challenging to face at times. Therefore, nurses are required to initiate self-care strategies in order to avoid burnout and psychological fatigue. Some of the three strategies to promote self-care include use of mental self-care, physical self-care and emotion self-care techniques (Crane & Ward, 2016). In terms of emotional self-care, the nurses should address the emotional needs in order to avoid stress after dealing with end-of-life care.

Basic emotional requirements of a nurse working in palliative care encompass having a feeling of belonging, being appreciated by others and sense of being understood. In most cases, nurses suffer from depression, and frustration hence become angry. In this respect, the nurse should use meditation techniques aimed at reducing levels of depression. Moreover, relaxation responses are important in promoting emotional wellbeing because they promotes attention and focus as well as minimizes blood pressure (Blum, 2014). Additionally, meditation practices are robust strategies that can enhance greater consciousness.

Secondly, mental self-care is a vital strategy that establishes positive effects on the behavior and attitude of the nurse. One such technique is mindfulness, which is closely linked to meditation (Blum, 2014). Specifically, this practice calls for maintenance of an awareness time-by-time of bodily sensations, feelings and thoughts. The strategy is very important as it help the nurse to pay close attention to reactions, emotions and physical sensations in a conscious way. Consequently, these programs are effect in reducing stress (Crane & Ward, 2016). Thirdly, physical well-being is important for the nurses that calls for physical self-care practices (Blum, 2014). More importantly, the techniques seeks to reactivate the parasympathetic nervous system, which play an important part in eliminating heart rate and blood pressure.

Some of the physical self-care programs include yoga, relaxation exercises and active exercises. Studies have confirmed that these physical activities have been linked to various positive health effects. For instance, regular exercises can play an important part in activating the relaxation reflexes hence alienating stress. Research by Crane & Ward, (2016) noted that nurses working in oncology setting should embrace regular physical exercise as they help to increase endorphin levels, reduce levels of blood sugar and blood pressure as well as enhance the general physical fitness (Crane & Ward, 2016).


Nursing practice calls for application of high standards of care when responding to the needs of the dying patient. In the case of Mr Newcomb, the nurse must introduce healthy communication in order to understand his wishes and priorities. Furthermore, the nurse must ensure that principles of Autonomy, Beneficence, Nonmaleficence and Justice are applied when providing nursing care. They should also use personal beliefs such as convictions, and values that they possess concerning death and life. Oncology care is one of the most challenging and stressful working environment in hospital settings among nurses. Therefore, nurses are required to initiate self-care strategies in order to avoid burnout and psychological fatigue. Some of the three strategies to promote self-care include use of mental self-care, physical self-care and emotion self-care techniques.


Blum, C. (2014). Practicing self-care for nurses: A nursing program initiative. OJIN: The Online Journal of Issues in Nursing, 19(3).

Butts, J. B., & Rich, K. L. (2012). Nursing ethics. Jones & Bartlett Publishers.

Crane, P. J., & Ward, S. F. (2016). Self-healing and self-care for nurses. AORN journal, 104(5), 386-400.

Grace, P. J. (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.

Izumi, S., Nagae, H., Sakurai, C., & Imamura, E. (2012). Defining end-of-life care from perspectives of nursing ethics. Nursing ethics, 19(5), 608-618.

Ranse, K., Yates, P., & Coyer, F. (2012). End-of-life care in the intensive care setting: a descriptive exploratory qualitative study of nurses’ beliefs and practices. Australian Critical Care, 25(1), 4-12.

Walker, A., & Breitsameter, C. (2015). Ethical decision-making in hospice care. Nursing ethics, 22(3), 321-330.

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